Background: Alcohol has been labeled as the “forgotten drug” of the HIV epidemic given that high levels of consumption co-occur with high HIV prevalence across sub-Saharan Africa. Alcohol use, particularly by male partners, has been associated with an increased risk of HIV infection and poorer HIV-related outcomes in Africa; however the role of alcohol use in relationships has been largely ignored. Research on the association between alcohol use and relationship quality is needed in order to inform ongoing couples-based approaches to HIV treatment and prevention.
Methods: We examined the association between alcohol use and relationship quality among 448 heterosexual couples participating in the baseline visit of Uthando Lwethu?a couples-based HIV-intervention trial in South Africa. Consistent with patterns of alcohol use in the region, women did not report alcohol use in our sample and thus we focused on male partner alcohol use only. We used the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) to categorized men as: abstainers (score = 0), non-hazardous drinkers (score = 1-3), or hazardous drinkers (score >=4). Relationship quality (RQ) was reported by both women and men using validated measures of intimacy, trust, communication, satisfaction and partner-support around HIV prevention and treatment (PS-HIV).
Results: Five separate structural equation models for each measure of RQ were fit using male partner alcohol use as a predictor of male and female RQ. Models used maximum likelihood estimation, controlling for age, education, marital status, and relationship duration. Results demonstrated that women paired with a hazardous drinker reported higher levels of intimacy (p < .05) and PS-HIV compared to women paired with abstainers. Men who were categorized as hazardous drinkers, compared to abstainers, reported less trust (p < .01) and more PS-HIV (p < .05).
Conclusions: Alcohol use by male partners was significantly associated with RQ, although the salience of RQ predictors differed by gender. Both men and women in couples with a male hazardous drinker reported higher levels of PS-HIV, however men also reported less trust in the relationship. These findings highlight the importance of addressing male alcohol use in couples-based approaches to HIV prevention and treatment that target relationship quality.